The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial

Mauricio Oliveira Magalhães; Luzilauri Harumi Muzi; Josielli Comachio; Thomaz Nogueira Burke; Fabio Jorge Renovato França; Luiz Armando Vidal Ramos; Gabriel Peixoto Leão Almeida; Ana Paula de Moura Campos Carvalho-e-Silva; Amélia Pasqual Marques

doi:10.1016/j.math.2015.02.004

The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial

Man Ther. 2015 Aug;20(4):603-9. doi: 10.1016/j.math.2015.02.004. Epub 2015 Feb 23.

Authors

Mauricio Oliveira Magalhães¹, Luzilauri Harumi Muzi², Josielli Comachio², Thomaz Nogueira Burke³, Fabio Jorge Renovato França², Luiz Armando Vidal Ramos⁴, Gabriel Peixoto Leão Almeida⁵, Ana Paula de Moura Campos Carvalho-e-Silva², Amélia Pasqual Marques²

Affiliations

¹ Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil. Electronic address: m.magalhaes@usp.br.
² Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
³ Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil; Bioscience Division, Federal University of São Paulo, São Paulo, Brazil.
⁴ Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil; University Federal do Amapá, Campus Binacional do Oiapoque, Amapá, Brazil.
⁵ Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil; Physical Therapy Division, School of Medicine, Federal University of Ceará, Ceará, Brazil.

PMID: 25749499
DOI: 10.1016/j.math.2015.02.004

Abstract

Background: Chronic low back pain is one of the most common problematic health conditions worldwide and is highly associated with disability, quality of life, emotional changes, and work absenteeism. Graded activity programs, based on cognitive behavioral therapy, and exercises are common treatments for patients with low back pain. However, recent evidence has shown that there is no evidence to support graded activity for patients with chronic nonspecific low back pain.

Aim: to compare the effectiveness of graded activity and physiotherapy in patients with chronic nonspecific low back pain.

Methods: A total of 66 patients with chronic nonspecific low back pain were randomized to perform either graded activity (moderate intensity treadmill walking, brief education and strength exercises) or physiotherapy (strengthening, stretching and motor control). These patients received individual sessions twice a week for six weeks. The primary measures were intensity of pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire).

Results: After six weeks, significant improvements have been observed in all outcome measures of both groups, with a non-significant difference between the groups. For intensity of pain (mean difference = 0.1 points, 95% confidence interval [CI] = -1.1-1.3) and disability (mean difference = 0.8 points, 95% confidence interval [CI] = -2.6-4.2). No differences were found in the remaining outcomes.

Conclusion: The results of this study suggest that graded activity and physiotherapy showed to be effective and have similar effects for patients with chronic nonspecific low back pain.

Keywords: Exercise; Low back pain; Physiotherapy; Rehabilitation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Behavior Control / methods*
Exercise
Exercise Therapy / methods*
Female
Health Education / methods*
Health Status
Humans
Low Back Pain / psychology
Low Back Pain / therapy*
Male
Middle Aged
Pain Measurement
Quality of Life